Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) are long flexors of the toes, often with the interconnecting tendinous slips at various points. These interconnecting slips hold great significance in reconstruction surgeries of ankle and foot such as chronic Achilles tendon rupture, posterior tibial tendon dysfunction (PTTD) and peroneal tendon rupture. In view of the above this study was aimed to find out various types of connections between tendons of FHL & FDL.Materials and methods: This cross sectional study was carried out in the Department of Anatomy ACSR Government Medical College, Nellore, conducted in a total of 34 lower limbs. Flexor digitorum brevis and abductor hallucis muscles were reflected distally after the removal of the skin, superficial fascia and plantar aponeurosis to expose FHL and FDL tendons which were examined for the interconnections. Specimens with interconnections were photographed and documented.Result: Out of 34 samples, 17 were right sided and 17 were of left sided. Mean foot length was 22.4 ± 1.9 cm. Three types of connections i.e. type 1, 4 & 5 were documented at 17 (50%), 16 (47.1%) and 1 (2.9%) type 5 respectively. Type 1 tendinous connections were further classified into 3 sub types i.e. type 1A were 10 (58.8%), type 1B were 5(29.4%) and type C were of 2(11.8%). Conclusion:This study finds maximum distribution of type1 interconnections followed by type 4 and sub type 1A among type 1. This study also reports for the first time a common origin of 1 st lumbrical from distal part of tendinous slip as well as from 1 st digital slip of FDL. These interconnections provide stable base and enhanced propulsion by toes and also act as natural tenodesis.
Pancreatic duct system shows wide range of variations/anomalies due to complexity in its development from two different sources namely Dorsal and Ventral pancreatic buds. Knowledge on these variations holds great importance during various surgical procedures such as drainage procedure in pancreatitis, pancreatico-jejunostomy, reconstruction after pancreatectomy and management of pancreatitis. The present study aims to explore different variations of pancreatic ducts.Materials and Methods: This cross sectional observational study was conducted in 39 pancreases. Posterior approach was chosen to expose the duct system. Two parallel incisions were made on the posterior surface of the pancreas. Tissue between these two incisions was removed by piece meal dissection and exposed the duct system.Observation and Results: out of 39 duct systems, 13 (33.3%) were normal and 26 (66.7%) were variations. These variations include 8 (20.5%) cases of Obliterated Duct of Santorini and 12 (30.76%) cases of absent Duct of Santorini, 4 (10.25%) complete pancreas divisum, 1 (2.56%) incomplete Pancreas divisum and 1 (2.56%) case of multiple ducts connecting main pancreatic duct and terminal CBD which is reported for the first time. Conclusion:Present study is in accordance with findings of most of the studies. Absent duct of Santorini was found to be higher (30.76%) among all types of variations and incomplete Pancreas Divisum with lowest occurrence (2.56%). The knowledge on the prevalence and various types of variations is highly recommended for the surgeons, Physicians and Radiologists for accurate diagnosis and efficient management of various diseases related to pancreas and pancreatico biliary apparatus.
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